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Modifiable Risk Factors & CVD

iStock-1359314170A paper published recently in The New England Journal of Medicine noted the not-exactly surprising finding that over fifty percent of incident cardiovascular disease and approximately twenty percent of deaths from any cause may be attributable to five modifiable risk factors: body mass index (BMI), systolic blood pressure, non-HDL cholesterol, current smoking, and diabetes.


What is a bit more revealing is that these five risk factors were associated with quite different hazard ratios for both cardiovascular disease (CVD) and all-cause mortality. Compared to BMI, non-HDL cholesterol, and systolic blood pressure, the hazard ratios associated with diabetes and current smoking were far higher, with diabetes more than doubling the risk among certain age groups.

This finding suggests – as does a growing body of other evidence – that focusing on reversing type 2 diabetes (and the underlying insulin resistance) may be a more fruitful pursuit for preventing or reducing the incidence of CVD as opposed to using non-HDL cholesterol as a key marker of cardiovascular health. Additionally, compared to non-HDL cholesterol (even at levels above 200 mg/dL), BMI, systolic blood pressure, and diabetes all appeared to confer far greater risk for all-cause mortality. Since obesity, hypertension, and elevated glucose are part of the diagnostic criteria for metabolic syndrome, addressing this – rather than targeting elevated cholesterol – may have a bigger positive impact on a patient’s health trajectory.

For this research, data were pooled from around the world (34 countries across six continents) and encompassed over 1.5 million participants (54 percent women; median age of 54.4 years), so these were diverse population groups.

It’s not news that addressing lifestyle factors is likely the best way to reduce cardiovascular risk and improve overall health. But this research suggests that prioritizing certain factors over others may be warranted for those who are unable to change everything simultaneously.

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